Ramblings of an Emergency Physician in Texas

Every cent raised for Project Valour-IT goes directly to the purchase and shipment of laptops for severely wounded service members. As of October 2007, Valour-IT has distributed over 1500 laptops to severely wounded Soldiers, Sailors, Airmen and Marines across the country...Originally Valour-IT provided the voice-controlled software, but now works closely with the Department of Defense Computer/electronic Accommodations Program (CAP): CAP supplies the adaptive software and Valour-IT provides the laptop. In addition, DoD caseworkers serve as Valour-IT?s ?eyes and ears? at several medical centers, identifying possible laptop recipients. …

Thanks to the efforts of the Military Order of the Purple Heart, Valour-IT is also able to reach patients in VA hospitals who would benefit from a Valour-IT laptop.

I’ve donated, and will either keep bumping this to the top periodically, or will put it in the sidebar (when I can figure out how to without flanging the display):

It was hard for me to decide on the USMC over the USN, but although my uniform said Navy and my paycheck said Navy, 80% of my time was spent with the grunts.I just sent them a couple of bucks. Could you?

It felt like a nasty sucker punch. Yet when he strained his eyes to the hard right, there was something that didn’t belong: the pewter-colored contour of a knife handle jutting from his skull.Sgt. Dan Powers, stabbed in the head by an insurgent on the streets of East Baghdad, triggered a modern miracle of military medicine, logistics, technology and air power.
…
His survival relied on the Army’s top vascular neurosurgeon guiding Iraq-based U.S. military physicians via laptop, the Air Force’s third nonstop medical evacuation from Central Command to America, and the best physicians Bethesda National Naval Medical Center in Maryland could offer.

It required extraordinary hustle from a string of ground medics, air medics, C-17 pilots, jet refuel technicians and more. Not an hour after the attack, Powers, a squad leader with the Army’s 118th Military Police Company, was draped in sheets on a medical gurney bound for Balad Air Force Base, about 30 minutes away by helicopter.

Watch a video of the examination of Sgt. Powers in Iraq, with the knife still in his head, here, courtesy of MilitaryTimes.

And, if you want to see one example of how hard the services work to save one life,

…the operations center was telling him to change planes, directing him toward a different C-17 Globemaster, one with a plus-sized fuel tank. Red 7, the center said, would be picking up a severely injured soldier from Balad to fly him nonstop to Andrews Air Force Base, Md., just outside Washington.

This week at Grand Rounds we are honoring health care professionals who serve their country by serving others. I want to thank Dr. Nick Genes for letting me host Grand Rounds this week, and I also want to thank everyone for all of their great submissions. The number of submissions that I received overwhelmed me, and apologize that I didn’t have room for every post. The artwork found in this week’s edition of Grand Rounds illustrates the history of military medicine, and the dedication of the men and women who care for patients in military medical facilities and outposts around the world. In the 1944 painting above by Jack McMillen, the artist depicts life at the Forest Glen annex of the Walter Reed Army Medical Center. The annex served as a holding and rehabilitation unit for medical patients, including psychiatric patients during World War II and in subsequent wars.

I’m embarrassed I couldn’t write a suitable post. I appreciate the hard-charging, dedicated and self-sacrificing Navy Corpsmen and Docs (I’m sure the lesser services have good people, too, but I didn’t live and work with them) and they deserve the respect of all, in and out of the service. It’s hard in a weird way to be the one whose role is to be ‘the soft one’, the one who cares for the warriors. It’s a job sometimes unappreciated by the warriors themselves, but that doesn’t make it any less important; in fact, that magnifies its importance. 19 year old males believe they’re bulletproof, and it’s our job to be there when reality strikes. My service was blessedly between wars, and nobody wanted to hear that Things Happen.

I genuinely liked my corpsmen, and hope they’re doing well, now 9-13 years since I was their leader. I hope they have the pride of a job well done, and understand the thanks of at least one ex-Navy Doc.

In this article I want to write about the pros and cons of the military as a way of financing medical education. I may not be fully aware of the recent changes to the HPSP program but I did a fair amount of research about the topic before I ended up not going though with it. I want whoever is thinking about doing this to think seriously and give it some critical thought before signing up.

A very thorough look at the dollars and decisions of being a military physician.

I got a phone message the other day, and today I got around to returning it.

“You are an ER Doctor, correct?” was the question. Yep.

“As you may know, we’re experiencing a critical shortage of Emergency Physicians in the Army Reserve, and I’ve been commissioned to contact as many Emergency Physicians as I can to offer them information about the Army Reserve. Are you interested?”. Nope. (I was nicer than that, but that was the gist of it).

I’m wondering how they got my number; since they called the work number, I’m guessing they got hold of an ACEP directory.

Baghdad ER is an HBO documentary, filming (a few) of the soldiers, Iraqis (and one Marine) who come through the Army’s 86th Combat Support Hospital in the Green Zone of Baghdad. It’s not to be missed.

First off, as an EM doc, I have absolutely no quibbles with the medical care shown. None. (You say: well, sure, you spent time in the military medical system, of course you’d say that. You couldn’t be more wrong. This is an Army Hospital, and I was in the Navy: there’s a friendly rivalry, to be polite.) I was very very pleased at the level of care shown. It didn’t, frankly, look any different than the care in any stateside hospital I’ve been in (except not enough use of emergency sonography is shown, but who knows if sonos were there and just not shown).

Second, this is a film for those who support the war and those who don’t. It’s just a good study of America’s all-volunteer military, and their all-volunteer healthcare providers. It’s neither pro- nor anti-war, and for this sort of film that’s all the balance you can hope for. Frankly, I found it a lot more even-handed than I expected.

Lastly, I’m very proud of my profession as it’s being practiced in Iraq by the US Army. This shows the US military as they are: individuals putting themselves out for each other. Wonderful.

Oh, and I was literally moved to tears, and I’m not easily emotional. I found myself wishing, briefly, I was back in uniform caring for the troops.

ASA March 2006 Newsletter: “March 2006
As warfare changes, so too must the care provided to injured soldiers. And at no time in history has military medical care been so advanced and so effective. This NEWSLETTER is devoted to the stories of those who have integrated educational advances into the combat care of our troops overseas.”

A series of articles about anesthesia care in combat environments. Excellent not just for the information, but also the insight to their practice environments.

WE SEND OUR American patients home?sometimes on their feet, sometimes in wheelchairs or on crutches or stretchers. Some of our patients are badly disfigured, and some have horrendous scars that can’t be seen. Others we send home in black body bags, after we lovingly wrap their bodies in woolen Army blankets. But send them home we do. We’re nurses of the 31st Combat Support Hospital in Baghdad, Iraq, and soldiers pass through our hands by the hundreds.

Besides American soldiers and marines, we care for coalition troops, Iraqi and foreign dignitaries, and ordinary civilians, including children and babies. We also take care of Iraqi soldiers, whether friend or foe. They all need our caring and our compassion, so we push ourselves to do more than we’d ever have thought possible.

Being a caregiver in a combat zone takes a special set of skills, and a lot of compassion. Thanks to all of you, from me.

I am acquainted with an excellent ER nurse, who was recently made mildly famous in a CNN profile for being recalled to active duty. However, while she knew she was being interviewed for an article about the difficulties of family separation, she expressed to me that the article was edited in a way that made her sound less than committed (‘sandbagged by the editor’ is how it was put to me), and wants to set the record straight.

I asked her to write whatever she wished regarding the CNN piece, and here’s what she has to say:

My name is Kathleen Whitney and I am an emergency room nurse and a 1st Lieutenant in the Army reserve. A few weeks ago I was featured in a story on CNN.com. Let me start out by saying that the author of that article was my aunt, and I don’t believe she would ever intentionally misrepresent me. However by the time the story got through the editors there was a definite liberal slant to it.

It is true that my plan when I became an officer was to remain in an army reserve unit until I became pregnant and then transfer to the IRR – (Inactive ready reserve) until my children were old enough to understand if I had to be deployed. So when I got the letter calling me out of the IRR it was quite a shock and I was a little angry. However what the article does not go on to say is that after much worrying and soul searching I came to this conclusion. It’s a war. It wasn’t meant to be easy on anyone. Many, countless people have already sacrificed more than I have even begun to. So right now my family and I just focus on ways to make things easier on my little boy, Matthew, if I do have to deploy somewhere. I feel no animosity towards the military or President Bush for recalling me and others out of the IRR. The needs of the country have to come first. And part of being a good parent, I think, means helping to make the world a better place for our children. I remember Sept. 11. I hope Matthew never lives to see another day like that – where Americans are attacked on our own soil.

One other thing that they neglected to mention in the article which I talked about in my interview was the guilt I already feel for not having been deployed. When I was eight months pregnant my unit deployed to Baghdad, Iraq. Of course there was no way I could have gone with them at eight months pregnant. So I kept in touch with them as best I could via e-mail and care packages. It never slipped my mind that while I was sitting in my air conditioned house rocking my new baby, my unit- the people I trained with, some of my best friends- were baking in the hot desert, enduring untold hardships. It is hard to describe the feeling I had then, and still have now. If I don’t deploy I am abandoning my country and my unit. If I do deploy I am abandoning my family. I am truly torn. In the end if I am called to go, I will go and be happy to serve. But I can not volunteer. Because me volunteering would also mean volunteering my mother to take care of my child full time. It would also mean volunteering my child to do without one of his parents for a year a more.

I hope that this rebuttal or addendum to the CNN article will clear up any questions of my loyalty that may have been brought up. Only time can tell what will happen from here.

emphasis mine

Good to hear from the source, we never questioned your patriotism. And, thank you for your service to our country.

SAN DIEGO, California (AP) — The hospital ship USNS Mercy returned home from Indonesia after treating thousands who survived the tsunami in December and thousands more who survived an earthquake in March.

The floating medical center and 270 crew members docked Wednesday at Naval Station San Diego to the cheers of families waving signs and balloons. The ship left port on Jan. 5.

"If you haven’t cried on this mission, you haven’t been on this mission," said Capt. Mark Llewellyn, repeating what he told his staff several times during the mission.

Arriving in Banda Aceh, Indonesia, in February, the Mercy’s advanced treatment facilities filled a desperate need. The tsunami, caused by a December 26 earthquake, killed more than 176,000 people in 11 countries and left about 50,000 missing and hundreds of thousands homeless.

The first 10 days of the mission, the Mercy’s first deployment since the Persian Gulf War more than a decade ago, saw nonstop orthopedic surgeries on injuries that had gone untreated for 11/2 months. By March, the military and civilian medical staff had treated 9,500 survivors.

"We saw a resiliency in those people that was hard to imagine," said Llewellyn, who ran the ship’s 1,000-bed hospital.

A Bucks County military doctor serving in Iraq says he was forced to shut down his Internet war diary last week after Army officials decided his gripping accounts of frontline medicine constituted a breach of Army regulations.
Maj. Michael Cohen, a doctor with the 67th Combat Support Hospital unit, had chronicled the bloody aftermath of the Dec. 21 mess-hall bombing in Mosul that killed 22. That account and 12 months of other postings on his Web log, www.67cshdocs.com, were replaced with a short notice:

“Levels above me have ordered, yes ORDERED, me to shut down this Web site. They cite that the information contained in these pages violates several Army Regulations,” Cohen wrote, adding that he disagreed with the ban…

This is the kind of crap that drove me out of the service. Some pinhead gets a bug in their ass, and we’re all expected to squirm.

I hope he keeps some sort of journal and publishes it when he’s out of the service (this should help the military doc reserve retention, eh?). Dumbasses. Quote me.

Last April, during the Iraqi invasion, I was watching MSNBC and saw one of my former corpsmen on TV. He made me proud of him and those like him, and I blogged about him at the time.

Last night, he found me through that entry here! My then HM3 Joe Gallardo is now HM1 Gallardo, and is an Independent Duty Corpsman (think PA school focused on the active duty person). He sent me the picture that accompanies this post, and that’s him in Iraq.

He also bragged on his family, three good looking kids, one on the way, and a spouse strong enough to raise a family and support a Navy man. I hope to hear more about him in the future, as his is as bright as I can imagine.

I said it then, and I’ll keep saying it: I’m glad he, and others like him are out there for us.

Saw your posting on a website and would like to inquire if you have any info on lemoore sar. I am currently the senior medic at lemoore sar and we are being decommisioned. We are looking for any info of people who knew lemoore sar or worked with them. Any help you can provide would be much appreciated.

HM2 Stephen Taylor
Lemoore SAR
stephen.taylor@navy.mil

There you are. I’m not going to turn this into a “lost my buddy” board, but as this is the first of these I’ve gotten, I felt it was interesting.